Stakeholder Discussion to Reduce Population-Wide Sodium Intake and Decrease Sodium in the Food Supply: A Conference Report From the American Heart Association Sodium Conference 2013 Planning Group

Perspective:

The following are 10 points to remember about the American Heart Association (AHA) sodium conference:

1. This 2-day forum focused on the health implications of sodium in the diet. Forum participants included 128 stakeholders who are engaged in food research and development, food manufacturing and retail, restaurant and food service operations, regulatory and legislative activities, public health initiatives, health care, academia and scientific research, and data monitoring and surveillance. Topics discussed included evidence for the benefits of health related to sodium reduction, public policy recommendations, past and present experience of the food industry, and implementation of recommendations to reduce sodium in the diet.

2. Currently, Americans consume >3400 mg of sodium per day, which increases their risk of hypertension, stroke, and other serious health problems. High blood pressure (BP) and high dietary sodium are believed to be responsible for >400,000 deaths annually among US adults.

3. Given that >75% of sodium consumption comes from sodium added to food before it is sold, Americans have relatively little control over how much sodium they consume, and it is often challenging to choose diets that are lower in sodium. There are wide ranges in sodium levels among packaged and restaurant foods, which suggest that there is an opportunity for substantial reductions in sodium that can go unnoticed by consumers.

4. The benefits of sodium reduction in people with poorly controlled BP are striking. In a trial of patients with resistant hypertension, a reduction in sodium intake by 4600 mg/d lowered systolic and diastolic BP by 22.7 and 9.1 mm Hg, respectively.

5. Sodium reduction also blunts the age-related rise in BP. Because BP rises with age, approximately 90% of adults eventually become hypertensive. The DASH Sodium trial demonstrated that sodium reduction to a level of approximately 1500 mg/d lowers BP more in older adults than younger adults. Systolic BP decreased by 8.1 mm Hg in those ages 55-76 years compared with 4.8 mm Hg in adults ages 23-41 years. In people without hypertension, BP decreased by 7.0 mm Hg in those >45 years of age compared with 3.7 mm Hg in those ≤45 years of age.

6. The AHA stated it believes in the health benefits of reducing sodium to <1500 mg/d based on strong scientific evidence. The long-term goal of 1500 mg of sodium per day can be achieved incrementally. Research has shown that behavioral modification techniques can help people reduce sodium, but these techniques alone have not been successful in decreasing population-wide sodium intake. Environmental and policy approaches to accompany behavior change strategies are needed to achieve a meaningful impact on the public’s health. Public policy approaches have successfully decreased population salt intakes in other countries including the United Kingdom and Finland.

7. Food manufacturers are under increasing pressure to reduce sodium, and improvements have been observed. Other critical government efforts include supporting robust sodium criteria within school nutrition standards, foods advertised and marketed to children, and foods purchased by employers or government feeding programs. The AHA also supports improved food labeling that helps consumers understand how much sodium is in the foods they purchase, and consumer education in restaurants to help consumers choose lower-sodium options. The association eagerly awaits the release of the federal government’s draft voluntary sodium targets for packaged and restaurant foods, which will be a critically important step for lowering sodium in the food supply.

8. Further research is critical, but calls for more research should not postpone efforts to meet current AHA guidelines for sodium reduction. Monitoring and surveillance should be continued and enhanced with regard to sodium knowledge, attitudes, and behaviors; sodium intake measurement; salt taste preference; and sodium content of foods. Maintenance of food and nutrient databases that reflect the current sodium content of the food supply will also be important to quantify population sodium intake.

9. The authors concluded that a well-established body of scientific research shows that there is a strong relationship between excess sodium intake and high BP and other adverse health outcomes. Since Americans are getting >75% of their sodium from processed and restaurant food, reducing sodium in the food supply could have significant health benefits. However, the reduction of sodium in the food supply is a complex issue that involves multiple stakeholders.

10. The success of new technological approaches for reducing sodium will depend on product availability, health effects (both intended and unintended), research and development investments, quality and taste of reformulated foods, supply chain management, operational modifications, consumer acceptance, and cost. The conference facilitated an exchange of ideas and set the stage for potential collaboration opportunities among stakeholders with mutual interest in reducing sodium in the food supply and in Americans’ diets.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, CHD & Pediatrics and Prevention, Diet, Hypertension

Keywords: Cooperative Behavior, Stroke, Great Britain, Food Supply, Food Labeling, Finland, Blood Pressure, Metabolic Syndrome X, Child, Diet, Sodium-Restricted, Hyponatremia, Sodium, Dietary, Cardiovascular Diseases, Nutritional Status, Restaurants, Hypertension, Hypernatremia


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